Smith, Maryellen T
Smith, Maryellen T is an individual health care provider with primary practice located at 1900 Centracare Cir #1300 Centracare Clinic - Women'S And Childrens, St Cloud MN 56303-5000. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is her primary health care specialty. Smith, Maryellen T can be contacted via phone (320) 654-3610.Contact Information
Primary practice address
1900 Centracare Cir #1300 Centracare Clinic - Women'S And Childrens
St Cloud MN 56303-5000
Phone: (320) 654-3610
Fax: (651) 702-5305
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 0735016 | Minnesota |
| Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X | R073501-6 | Minnesota |
Profile Details
| NPI number | 1225004377 |
|---|---|
| LBN Legal business name | Smith, Maryellen T |
| Credentials | Certified Pediatric Nurse Practitioner (CPNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 28th, 2006 |
| Last updated | Sep 7th, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225004377 | NPPES |
| Minnesota | MEDICAID | 071742800 |
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